Longitudinal Evidence on Natural History, Nonoperative Management, and Multimodal Surveillance in Mild to Moderate Degenerative Cervical Myelopathy: A Scoping Review.

Abstract

Study DesignScoping review.ObjectivesTo map longitudinal evidence on natural history, nonoperative management, progression definitions, clinical decision variables, and multimodal surveillance in mild to moderate degenerative cervical myelopathy (DCM), while distinguishing the treatment implications of mild and moderate disease.MethodsPubMed/MEDLINE, Embase, Web of Science Core Collection, Scopus, and the Cochrane Library were searched from inception to March 22, 2026. The review followed PRISMA-ScR. Eligible studies were adult longitudinal reports of mild or moderate DCM/cervical spondylotic myelopathy, extractable mild/moderate subgroups, or clinically relevant progression-surveillance evidence. Data were charted for design, population, management, follow-up, endpoints, progression definitions, examination findings, imaging variables, CT-relevant pathology, and alignment or motion factors.ResultsOf 6,193 records, 4,137 remained after deduplication and 766 underwent full-text consideration. Thirty-two reports underwent final eligibility assessment; 28 were retained, including 13 main analytic studies, 7 supplementary or conditional studies, and 8 adjunct multimodal narrative studies. Evidence was heterogeneous in severity thresholds, progression definitions, endpoints, and follow-up schedules. Nonoperative and natural-history cohorts showed that mild to moderate disease is not uniformly stable; some patients remained stable, whereas others deteriorated or crossed over to surgery. Objective function, quantitative MRI, electrophysiology, and selected structural measures may detect change more sensitively than symptom scales or conventional MRI alone.ConclusionsMild to moderate DCM represents a surveillance population, but mild and moderate disease should not be treated as having identical indications. Nonoperative cohorts help define progression and escalation risk, and multimodal follow-up appears more informative than single-scale monitoring.